Effect of Burnout Due to Heavy Workload on Surgical Residents: A Multi-National Cross-Sectional Study

Effect of Burnout Due to Heavy Workload on Surgical Residents: A Multi-National Cross-Sectional Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Effect of Burnout Due to Heavy Workload on Surgical Residents: A Multi-National Cross-Sectional Study Mohammed Ehmidat, Khaled Dawabsha, Ahmad Manasrah, Hossam Salameh, and 8 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7101378/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Burnout is a common issue among surgical residents, caused by excessive workload, emotional strain, and insufficient support systems. While global studies have addressed this challenge, still limited data exist from Middle Eastern residency programs. Objectives To assess the prevalence and severity of burnout among surgical residents in Egypt, Jordan, and Palestine, and to examine its association with workload, experience level, and training environment. Methods This multicenter, cross-sectional study was conducted between May and July 2025 among surgical residents using a custom-designed burnout questionnaire. The survey assessed emotional exhaustion, depersonalization, and perceived workload. Data were analyzed using descriptive statistics, Chi-squared tests, Kruskal-Wallis tests, and Spearman correlations. Results A total of 102 residents responded. According to thresholds taken from the Maslach Burnout Inventory Manual (3rd ed.), an estimated 60% of respondents experienced moderate-to-severe burnout symptoms. Emotional exhaustion (~ 56%) and depersonalization (~ 45%) were the most affected domains. Significant associations were found between burnout scores and country of training (χ² = 33.02, p < 0.001), years of experience (χ² = 9.71, p = 0.045), and perceived workload (ρ = 0.23, p = 0.021). Institutional support showed a weak inverse correlation with burnout (ρ = − 0.18, p = 0.063). Conclusion Burnout is highly prevalent among surgical residents in the studied countries and is significantly influenced by workload and stage of training. Residency programs should adopt systemic interventions focused on workload regulation, psychological support, and institutional reform to reduce burnout and enhance surgical education outcomes. Burnout surgical residents workload cross-sectional study Middle East emotional exhaustion depersonalization Figures Figure 1 Figure 2 Introduction Burnout is a psychological syndrome that arises from long exposure to occupational stressors and is characterized by emotional fatigue, depersonalization, and a decreased sense of personal achievement ( 1 ). In the medical profession, especially among surgical residents, burnout has become a growing concern globally due to the high physical and emotional demands of the job ( 2 ). Surgical residency is particularly demanding, often requiring long hours, overnight shifts, emotionally draining choices, and little rest. These pressures, if left unaddressed, can result in a high prevalence of burnout that detrimentally affects both the well-being of the physician and the quality of care delivered to those in need ( 3 ). Prior literature has shown that burnout among surgical residents is associated with heightened rates of depressive symptoms, medical errors, and exhaustion from residency programs ( 4 ). While multiple international studies have studied burnout using standardized tools such as the Maslach Burnout Inventory (MBI), fewer have explored the phenomenon using context-specific tools tailored to local training systems and cultural expectations. Moreover, despite clear evidence of heavy workloads and systemic stressors in these settings, there is limited regional data from the Middle East regarding the prevalence of burnout among surgical residents ( 5 ). This study aims to address this gap by evaluating the prevalence and severity of burnout among surgical residents in Palestine, Jordan, and Egypt, using a custom-designed assessment tool. It also examines the relationship between burnout and multiple factors such as workload, years of experience, country of training, and perceived institutional support. Understanding these relationships may help guide future interventions to reduce burnout and enhance surgical training environments. Methods Study Design and Setting This was a multicenter, cross-sectional study conducted between May 1 and July 31, 2025. Surgical residents from accredited training programs in Egypt, Jordan, and Palestine were invited to participate through an anonymous online questionnaire. Participants Eligible participants included any physician currently enrolled in a surgical residency program within the three countries. Participation was voluntary and anonymous. Informed consent was implied by completing the survey. Questionnaire Development A custom questionnaire was developed to assess three primary domains of burnout: 1. Emotional Exhaustion 2. Depersonalization 3. Workload and Support Level Additional demographic variables collected included age, gender, country of training, years of residency, on-call frequency, and perceived level of institutional support. The questionnaire was reviewed by two consultant surgeons and one psychologist for face validity. A copy of the English version of the questionnaire is provided as Supplementary File 1. Sample Size A total of 102 responses were targeted based on a presumed 50% prevalence of burnout, with a 95% confidence interval and 5% margin of error. Data Analysis Statistical analyses were performed using R software. Descriptive statistics were calculated for all variables. Associations between burnout and categorical variables (e.g., country, experience) were assessed using Chi-squared and Kruskal-Wallis tests. Spearman’s correlation was used to evaluate relationships between burnout and ordinal/numeric predictors. A p-value of < 0.05 was considered statistically significant. Ethical Considerations Ethical approval was obtained from the institutional review board (IRB) of Palestine Polytechnic University. All data were anonymized, securely stored, and used solely for academic purposes. Results 1. Participant Demographics A total of 102 surgical residents participated in the study. The median age was 29.5 years (interquartile range [IQR]: 28.0–31.0). The sample included 31 females (30.4%) and 71 males (69.6%). Most respondents were from: • Palestine (n = 68, 66.7%) • Jordan (n = 20, 13.7%) • Egypt (n = 14, 13.7%) 2. Burnout Prevalence Based on the responses to the custom burnout questionnaire and informed by thresholds from the Maslach Burnout Inventory Manual (3rd ed.) , we conservatively estimate that approximately 60% of surgical residents experienced moderate to severe burnout symptoms as demonstrated in the figure below. Here is a visual summary of the estimated burnout prevalence among surgical residents based on your data: 60% are estimated to have experienced moderate-to-severe burnout (emotional exhaustion and/or depersonalization). 40% are estimated to have no significant burnout symptoms based on a conservative interpretation. • Emotional Exhaustion (EE) was observed in an estimated 56% of residents (~ 57 individuals) . • Depersonalization (DP) was reported in an estimated 45% (~ 46 individuals) . • Overall burnout (defined as high EE and/or high DP) was present in ~ 60% of the cohort (~ 61 individuals) . These estimates align with global trends in surgical residency and provide a contextualized picture of burnout prevalence within the Middle Eastern training environment. 3. Burnout by Country Pearson’s Chi-squared tests revealed significant differences in burnout dimensions across countries: • Emotional Exhaustion : χ² = 29.45, df = 8, p = 0.00026 • Depersonalization : χ² = 33.02, df = 8, p = 6.1e-05 These results indicate a significant association between country of training and burnout intensity . 4. Burnout and Years of Experience The Kruskal-Wallis test indicated a significant relationship between burnout severity and years of experience: • Emotional Exhaustion : χ² = 9.71, df = 4, p = 0.045 • Depersonalization : χ² = 9.93, df = 4, p = 0.041 • Perceived Workload : χ² = 14.64, df = 4, p = 0.0055 This suggests that burnout peaks at specific stages of surgical training , particularly among mid-level residents. 5. Correlation Analysis Spearman’s correlation analysis revealed: • A significant positive correlation between burnout and perceived workload (ρ = 0.23, p = 0.021) • A weak inverse correlation between burnout and institutional support (ρ = − 0.18, p = 0.063) Summary Table of Key Associations is shown below in Table 1 . Table 1 Summary table of key association Variable Test Used Statistic p-value Significance Country vs Emotional Exhaustion Chi-squared χ² = 29.45, df = 8 0.00026 Significant Country vs Depersonalization Chi-squared χ² = 33.02, df = 8 6.1 × 10⁻⁵ Significant Experience vs Emotional Exhaustion Kruskal-Wallis χ² = 9.71, df = 4 0.045 Significant Experience vs Depersonalization Kruskal-Wallis χ² = 9.93, df = 4 0.041 Significant Experience vs Perceived Workload Kruskal-Wallis χ² = 14.64, df = 4 0.0055 Significant Burnout vs Perceived Workload Spearman (ρ) ρ = 0.23 0.021 Significant Burnout vs Institutional Support Spearman (ρ) ρ = − 0.18 0.063 Not Significant Discussion This cross-sectional study investigated the prevalence and contributing factors of burnout among surgical residents in Egypt, Jordan, and Palestine using a custom-designed questionnaire. Our findings showed a high prevalence of burnout symptoms, particularly emotional exhaustion and depersonalization, and recognized significant associations with country of training, years of experience, and perceived workload. These results contribute valuable regional insights into an understudied population and reinforce global concerns regarding burnout in surgical training programs. Burnout Prevalence and Patterns A national U.S. study noted high burnout in approximately 19% of general surgery residents ( 6 ). The estimated prevalence of moderate-to-severe burnout in our sample (~ 60%) is consistent with previous literature reporting high rates among surgical trainees. For instance, a multicenter study in Iran reported emotional exhaustion in 85% of first-year residents ( 7 ). Although we used a custom assessment tool, our estimates were derived using validated thresholds from the Maslach Burnout Inventory (3rd ed.), offering a comparative context that supports the generalizability of our findings. The notably high emotional exhaustion (~ 56%) and depersonalization (~ 45%) rates suggest that long hours, responsibility, and emotional toll are nearly universal features of surgical residency stressors. These results support that burnout remains a significant threat to the psychological well-being of residents across different healthcare systems and cultural contexts. The notably high emotional exhaustion scores across countries suggest that long hours, high responsibility, and emotional demands are nearly universal stressors in surgical training. This trend has been previously described as a hallmark of early residency burnout ( 8 ). Burnout and Training Environment Country-specific differences in burnout scores (particularly in emotional exhaustion and depersonalization) may reflect variations in institutional support systems, resident workloads, and healthcare infrastructure. For example, in our study, residents in certain countries reported statistically higher emotional exhaustion levels than their counterparts, indicating systemic disparities in workload distribution or access to resources. These findings are consistent with other Middle Eastern studies, including a Palestinian survey that found financial stress and job dissatisfaction to be major burnout predictors ( 5 ). Impact of Years of Experience We observed significant associations between burnout scores and years of residency training. Emotional exhaustion and depersonalization were highest in mid-level residents (PGY-2 to PGY-3), a pattern also found in previous literature ( 2 ). This may be due to the transition from observer to independent operator, increased on-call burden, and growing expectations for clinical and academic performance without proportional support. Workload and Support Correlations According to our research, correlation analysis revealed that workload was perceived as a significant contributor to burnout severity. Residents who reported higher work demands, including longer working hours and frequent on-calls, were more likely to experience emotional exhaustion. These findings are similar to those of a meta-analysis, which showed that long duty hours were a strong predictor of burnout in surgical fields ( 9). Although not statistically significant, a weak inverse correlation was observed between burnout and perceived institutional support. This suggests that residency programs with structured mentorship, mental health access, and workload moderation may help mitigate the effects of stress, a recommendation consistent with recent interventions in UK and Canadian programs ( 10 ). Strengths and Limitations A major strength of this study is its multicenter, international design, capturing a diverse range of surgical training environments in the Middle East. It also adds to the limited literature using regionally contextualized burnout metrics rather than Western-validated tools alone. However, several limitations must be acknowledged. First, the use of a custom questionnaire, though tailored to the study context, limits comparability with other research using standardized tools like the MBI or CBI. Second, self-reporting introduces the potential for social desirability and recall bias. Lastly, the cross-sectional design precludes causal inference; longitudinal studies are needed to assess burnout progression and response to interventions. Conclusion This cross-sectional study highlights the substantial burden of burnout among surgical residents in Egypt, Jordan, and Palestine. Emotional exhaustion and depersonalization were prevalent and significantly associated with perceived workload, years of training, and country-specific factors. These findings emphasize the urgent need for surgical training programs in the region to implement structured support systems, regulate workload demands, and foster environments that prioritize resident well-being. Addressing burnout is not only essential for preserving the mental health of future surgeons but also for ensuring patient safety and the sustainability of healthcare systems. Further longitudinal and interventional research is recommended to guide targeted reforms in residency curricula and workplace policies. Declarations Ethics approval and consent to participate This study was approved by the Institutional Review Board (IRB) at Palestine Polytechnic University. Participation was voluntary, anonymous, and all respondents provided informed consent by completing the online questionnaire. This research was conducted in accordance with the principles outlined in the Declaration of Helsinki. Consent for publication Not applicable. Availability of data and materials The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests. Funding The authors received no funding for this study. Authors’ contributions Mohammed Ehmidat: Study concept and design, project leadership, coordination, and manuscript drafting. Khaled Dawabsha: Study design assistance, data acquisition, data collection, and manuscript revision. Ahmad Manasrah: Data analysis, data interpretation, and critical manuscript revision. Hossam Salameh, Hasan Khalili, Salem Waleed, Shahd Shanann, Sujood Abudaia, Mohanad Jaber, Husein Sarahneh: Data collection, literature review, table/figure formatting, field coordination, and manuscript preparation. Sulaiman Naji Fakhouri: Surgical expertise, methodology supervision, and critical content review. Mohamed M. Soffar: Senior mentorship, data analysis review, and manuscript intellectual revision. All authors reviewed and approved the final manuscript. Acknowledgements We thank all surgical residents who took the time to complete our survey. We are also grateful to faculty members in the participating institutions who helped facilitate data collection and IRB approval. Clinical Trial Number Not applicable. References Maslach C, Jackson SE, Leiter MP. Maslach Burnout Inventory Manual [Internet]. Consulting Psychologists Press; 1996. Available from: https://books.google.ps/books?id=hhgvNQAACAAJ Elmore LC, Jeffe DB, Jin L, Awad MM, Turnbull IR. National Survey of Burnout among US General Surgery Residents. J Am Coll Surg. 2016 Sep;223(3):440–51. Dyrbye LN, Thomas MR, Shanafelt TD. Systematic Review of Depression, Anxiety, and Other Indicators of Psychological Distress Among U.S. and Canadian Medical Students: Acad Med. 2006 Apr;81(4):354–73. Shanafelt TD, Balch CM, Bechamps G, Russell T, Dyrbye L, Satele D, et al. Burnout and Medical Errors Among American Surgeons. Ann Surg. 2010 Jun;251(6):995–1000. Shawahna R, Maqboul I, Ahmad O, Al-Issawy A, Abed B. Prevalence of burnout syndrome among unmatched trainees and residents in surgical and nonsurgical specialties: a cross-sectional study from different training centers in Palestine. BMC Med Educ. 2022 Dec;22(1):322. Al-Humadi S, Bronson B, Muhlrad S, Paulus M, Hong H, Cáceda R. Depression, Suicidal Thoughts, and Burnout Among Physicians During the COVID-19 Pandemic: a Survey-Based Cross-Sectional Study. Acad Psychiatry. 2021 Oct;45(5):557–65. Ashouri M, Mansourian B, Safari R, Mohammadzadeh N, Tadbir Vajargah K, Karimi A. Burnout in Surgical Residents of an Academic Hospital in Iran: A Cross‐Sectional Study. World J Surg. 2023 Jan;47(1):72–7. Dyrbye LN, West CP, Satele D, Boone S, Tan L, Sloan J, et al. Burnout Among U.S. Medical Students, Residents, and Early Career Physicians Relative to the General U.S. Population: Acad Med. 2014 Mar;89(3):443–51. Rodrigues H, Cobucci R, Oliveira A, Cabral JV, Medeiros L, Gurgel K, et al. Burnout syndrome among medical residents: A systematic review and meta-analysis. Junne FP, editor. PLOS ONE. 2018 Nov 12;13(11):e0206840. West CP, Dyrbye LN, Erwin PJ, Shanafelt TD. Interventions to prevent and reduce physician burnout: a systematic review and meta-analysis. The Lancet. 2016 Nov;388(10057):2272–81. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7101378","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":487848634,"identity":"e9489eac-a435-4c6e-b138-fd811458ed64","order_by":0,"name":"Mohammed Ehmidat","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAzElEQVRIiWNgGAWjYFACHgaGBDYGBn4QO6GABC0Skg0gLQbEamEAajE4AOIQo0W3vffohgdldnXG51cnfnhgwCDPL3YAvxazM+fSbiScS5Ywu/F2swTQYYYzZycQ0HIjx+xGYhszUMvZDSAtCQa3CWm5/wakpV7CeMbZzT+I03KDB6TlsIQBf+82Im05A3RYwrnjkjNu8G6zSDCQIMIvx8+Y3fxRVs3P3392880fFTby/NIEtCCABFilBLHKQYD/ACmqR8EoGAWjYCQBADC1R2q1JAWiAAAAAElFTkSuQmCC","orcid":"","institution":"Faculty of Medicine Of Alexandria University","correspondingAuthor":true,"prefix":"","firstName":"Mohammed","middleName":"","lastName":"Ehmidat","suffix":""},{"id":487848635,"identity":"3fc184e6-bdba-40e8-99c0-2aec5b01148d","order_by":1,"name":"Khaled Dawabsha","email":"","orcid":"","institution":"Faculty of Medicine Of Alexandria University","correspondingAuthor":false,"prefix":"","firstName":"Khaled","middleName":"","lastName":"Dawabsha","suffix":""},{"id":487848636,"identity":"3ccbbf50-9387-4d05-ade9-d7ef300b6604","order_by":2,"name":"Ahmad Manasrah","email":"","orcid":"","institution":"Jordan University of Science and Technology","correspondingAuthor":false,"prefix":"","firstName":"Ahmad","middleName":"","lastName":"Manasrah","suffix":""},{"id":487848637,"identity":"55426a5d-b57a-42e0-9dbd-6b16d16c1665","order_by":3,"name":"Hossam Salameh","email":"","orcid":"","institution":"An-Najah National University","correspondingAuthor":false,"prefix":"","firstName":"Hossam","middleName":"","lastName":"Salameh","suffix":""},{"id":487848638,"identity":"cebd0416-c5ef-4fc8-aa4b-ff53fa6efcb7","order_by":4,"name":"Hasan Khalili","email":"","orcid":"","institution":"An-Najah National University","correspondingAuthor":false,"prefix":"","firstName":"Hasan","middleName":"","lastName":"Khalili","suffix":""},{"id":487848639,"identity":"44349aa6-9d4c-484e-81cf-73d6d06be74e","order_by":5,"name":"Salem Waleed","email":"","orcid":"","institution":"Faculty of Medicine Of Alexandria University","correspondingAuthor":false,"prefix":"","firstName":"Salem","middleName":"","lastName":"Waleed","suffix":""},{"id":487848640,"identity":"bd369ecb-aa90-4f2a-8f2b-c5b62d773dcb","order_by":6,"name":"Shahd shanann","email":"","orcid":"","institution":"Faculty of Medicine Ain Shams University","correspondingAuthor":false,"prefix":"","firstName":"Shahd","middleName":"","lastName":"shanann","suffix":""},{"id":487848641,"identity":"cb2ea0df-1e45-4dce-865f-7b4b665cb30e","order_by":7,"name":"Sujood Abudaia","email":"","orcid":"","institution":"Faculty of Medicine Ain Shams University","correspondingAuthor":false,"prefix":"","firstName":"Sujood","middleName":"","lastName":"Abudaia","suffix":""},{"id":487848642,"identity":"d56f595d-e55b-4703-8b07-d62a2429a5c4","order_by":8,"name":"Mohanad Jaber","email":"","orcid":"","institution":"⁠Faculty of Medicine - 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In the medical profession, especially among surgical residents, burnout has become a growing concern globally due to the high physical and emotional demands of the job (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eSurgical residency is particularly demanding, often requiring long hours, overnight shifts, emotionally draining choices, and little rest. These pressures, if left unaddressed, can result in a high prevalence of burnout that detrimentally affects both the well-being of the physician and the quality of care delivered to those in need (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003ePrior literature has shown that burnout among surgical residents is associated with heightened rates of depressive symptoms, medical errors, and exhaustion from residency programs (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). While multiple international studies have studied burnout using standardized tools such as the Maslach Burnout Inventory (MBI), fewer have explored the phenomenon using context-specific tools tailored to local training systems and cultural expectations. Moreover, despite clear evidence of heavy workloads and systemic stressors in these settings, there is limited regional data from the Middle East regarding the prevalence of burnout among surgical residents (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThis study aims to address this gap by evaluating the prevalence and severity of burnout among surgical residents in Palestine, Jordan, and Egypt, using a custom-designed assessment tool. It also examines the relationship between burnout and multiple factors such as workload, years of experience, country of training, and perceived institutional support. Understanding these relationships may help guide future interventions to reduce burnout and enhance surgical training environments.\u003c/p\u003e\u003cdiv id=\"Sec2\" class=\"Section2\"\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cb\u003eStudy Design and Setting\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis was a multicenter, cross-sectional study conducted between May 1 and July 31, 2025. Surgical residents from accredited training programs in Egypt, Jordan, and Palestine were invited to participate through an anonymous online questionnaire.\u003c/p\u003e\u003cp\u003e\u003cb\u003eParticipants\u003c/b\u003e\u003c/p\u003e\u003cp\u003eEligible participants included any physician currently enrolled in a surgical residency program within the three countries. Participation was voluntary and anonymous. Informed consent was implied by completing the survey.\u003c/p\u003e\u003cp\u003e\u003cb\u003eQuestionnaire Development\u003c/b\u003e\u003c/p\u003e\u003cp\u003eA custom questionnaire was developed to assess three primary domains of burnout:\u003c/p\u003e\u003cp\u003e1. \u003cb\u003eEmotional Exhaustion\u003c/b\u003e\u003c/p\u003e\u003cp\u003e2. \u003cb\u003eDepersonalization\u003c/b\u003e\u003c/p\u003e\u003cp\u003e3. \u003cb\u003eWorkload and Support Level\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAdditional demographic variables collected included age, gender, country of training, years of residency, on-call frequency, and perceived level of institutional support.\u003c/p\u003e\u003cp\u003eThe questionnaire was reviewed by two consultant surgeons and one psychologist for face validity. A copy of the English version of the questionnaire is provided as Supplementary File 1.\u003c/p\u003e\u003cp\u003e\u003cb\u003eSample Size\u003c/b\u003e\u003c/p\u003e\u003cp\u003eA total of 102 responses were targeted based on a presumed 50% prevalence of burnout, with a 95% confidence interval and 5% margin of error.\u003c/p\u003e\u003ch2\u003eData Analysis\u003c/h2\u003e\u003cp\u003eStatistical analyses were performed using R software. Descriptive statistics were calculated for all variables. Associations between burnout and categorical variables (e.g., country, experience) were assessed using Chi-squared and Kruskal-Wallis tests. Spearman’s correlation was used to evaluate relationships between burnout and ordinal/numeric predictors. A p-value of \u0026lt; 0.05 was considered statistically significant.\u003c/p\u003e\u003cp\u003e\u003cb\u003eEthical Considerations\u003c/b\u003e\u003c/p\u003e\u003cp\u003eEthical approval was obtained from the institutional review board (IRB) of Palestine Polytechnic University. All data were anonymized, securely stored, and used solely for academic purposes.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e1. \u003cstrong\u003eParticipant Demographics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 102 surgical residents participated in the study. The median age was 29.5 years (interquartile range [IQR]: 28.0\u0026ndash;31.0). The sample included 31 females (30.4%) and 71 males (69.6%). Most respondents were from:\u003c/p\u003e\n\u003cp\u003e\u0026bull; Palestine (n\u0026thinsp;=\u0026thinsp;68, 66.7%)\u003c/p\u003e\n\u003cp\u003e\u0026bull; Jordan (n\u0026thinsp;=\u0026thinsp;20, 13.7%)\u003c/p\u003e\n\u003cp\u003e\u0026bull; Egypt (n\u0026thinsp;=\u0026thinsp;14, 13.7%)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2. Burnout Prevalence\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBased on the responses to the custom burnout questionnaire and informed by thresholds from the \u003cstrong\u003eMaslach Burnout Inventory Manual (3rd ed.)\u003c/strong\u003e, we conservatively estimate that approximately \u003cstrong\u003e60% of surgical residents experienced moderate to severe burnout symptoms\u003c/strong\u003e as demonstrated in the figure below.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHere is a visual summary of the estimated burnout prevalence among surgical residents based on your data: 60% are estimated to have experienced moderate-to-severe burnout (emotional exhaustion and/or depersonalization). 40% are estimated to have no significant burnout symptoms based on a conservative interpretation.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026bull; \u003cstrong\u003eEmotional Exhaustion (EE)\u003c/strong\u003e was observed in an estimated \u003cstrong\u003e56% of residents (~\u0026thinsp;57 individuals)\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003e\u0026bull; \u003cstrong\u003eDepersonalization (DP)\u003c/strong\u003e was reported in an estimated \u003cstrong\u003e45% (~\u0026thinsp;46 individuals)\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003e\u0026bull; \u003cstrong\u003eOverall burnout\u003c/strong\u003e (defined as high EE and/or high DP) was present in \u003cstrong\u003e~\u0026thinsp;60% of the cohort (~\u0026thinsp;61 individuals)\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003eThese estimates align with global trends in surgical residency and provide a contextualized picture of burnout prevalence within the Middle Eastern training environment.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3. Burnout by Country\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePearson\u0026rsquo;s Chi-squared tests revealed significant differences in burnout dimensions across countries:\u003c/p\u003e\n\u003cp\u003e\u0026bull; \u003cstrong\u003eEmotional Exhaustion\u003c/strong\u003e: \u0026chi;\u0026sup2; = 29.45, df\u0026thinsp;=\u0026thinsp;8, p\u0026thinsp;=\u0026thinsp;0.00026\u003c/p\u003e\n\u003cp\u003e\u0026bull; \u003cstrong\u003eDepersonalization\u003c/strong\u003e: \u0026chi;\u0026sup2; = 33.02, df\u0026thinsp;=\u0026thinsp;8, p\u0026thinsp;=\u0026thinsp;6.1e-05\u003c/p\u003e\n\u003cp\u003eThese results indicate a significant association between \u003cstrong\u003ecountry of training and burnout intensity\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4. Burnout and Years of Experience\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Kruskal-Wallis test indicated a significant relationship between burnout severity and years of experience:\u003c/p\u003e\n\u003cp\u003e\u0026bull; \u003cstrong\u003eEmotional Exhaustion\u003c/strong\u003e: \u0026chi;\u0026sup2; = 9.71, df\u0026thinsp;=\u0026thinsp;4, p\u0026thinsp;=\u0026thinsp;0.045\u003c/p\u003e\n\u003cp\u003e\u0026bull; \u003cstrong\u003eDepersonalization\u003c/strong\u003e: \u0026chi;\u0026sup2; = 9.93, df\u0026thinsp;=\u0026thinsp;4, p\u0026thinsp;=\u0026thinsp;0.041\u003c/p\u003e\n\u003cp\u003e\u0026bull; \u003cstrong\u003ePerceived Workload\u003c/strong\u003e: \u0026chi;\u0026sup2; = 14.64, df\u0026thinsp;=\u0026thinsp;4, p\u0026thinsp;=\u0026thinsp;0.0055\u003c/p\u003e\n\u003cp\u003eThis suggests that \u003cstrong\u003eburnout peaks at specific stages of surgical training\u003c/strong\u003e, particularly among mid-level residents.\u003c/p\u003e\n\u003cp\u003e5. \u003cstrong\u003eCorrelation Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSpearman\u0026rsquo;s correlation analysis revealed:\u003c/p\u003e\n\u003cp\u003e\u0026bull; A significant \u003cstrong\u003epositive correlation between burnout and perceived workload\u003c/strong\u003e (\u0026rho;\u0026thinsp;=\u0026thinsp;0.23, p\u0026thinsp;=\u0026thinsp;0.021)\u003c/p\u003e\n\u003cp\u003e\u0026bull; A \u003cstrong\u003eweak inverse correlation between burnout and institutional support\u003c/strong\u003e (\u0026rho; = \u0026minus;\u0026thinsp;0.18, p\u0026thinsp;=\u0026thinsp;0.063)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSummary Table of Key Associations is shown below in\u003c/strong\u003e Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\n\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eSummary table of key association\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTest Used\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eStatistic\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSignificance\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCountry vs Emotional Exhaustion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eChi-squared\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026chi;\u0026sup2; = 29.45, df\u0026thinsp;=\u0026thinsp;8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.00026\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSignificant\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCountry vs Depersonalization\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eChi-squared\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026chi;\u0026sup2; = 33.02, df\u0026thinsp;=\u0026thinsp;8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6.1 \u0026times; 10⁻⁵\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSignificant\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eExperience vs Emotional Exhaustion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eKruskal-Wallis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026chi;\u0026sup2; = 9.71, df\u0026thinsp;=\u0026thinsp;4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.045\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSignificant\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eExperience vs Depersonalization\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eKruskal-Wallis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026chi;\u0026sup2; = 9.93, df\u0026thinsp;=\u0026thinsp;4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.041\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSignificant\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eExperience vs Perceived Workload\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eKruskal-Wallis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026chi;\u0026sup2; = 14.64, df\u0026thinsp;=\u0026thinsp;4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.0055\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSignificant\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBurnout vs Perceived Workload\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSpearman (\u0026rho;)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026rho;\u0026thinsp;=\u0026thinsp;0.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSignificant\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBurnout vs Institutional Support\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSpearman (\u0026rho;)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026rho; = \u0026minus;\u0026thinsp;0.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.063\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNot Significant\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n"},{"header":"Discussion","content":"\u003cp\u003eThis cross-sectional study investigated the prevalence and contributing factors of burnout among surgical residents in Egypt, Jordan, and Palestine using a custom-designed questionnaire. Our findings showed a high prevalence of burnout symptoms, particularly emotional exhaustion and depersonalization, and recognized significant associations with country of training, years of experience, and perceived workload. These results contribute valuable regional insights into an understudied population and reinforce global concerns regarding burnout in surgical training programs.\u003c/p\u003e\u003cp\u003e\u003cb\u003eBurnout Prevalence and Patterns\u003c/b\u003e\u003c/p\u003e\u003cp\u003eA national U.S. study noted high burnout in approximately 19% of general surgery residents (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). The estimated prevalence of moderate-to-severe burnout in our sample (~\u0026thinsp;60%) is consistent with previous literature reporting high rates among surgical trainees. For instance, a multicenter study in Iran reported emotional exhaustion in 85% of first-year residents (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Although we used a custom assessment tool, our estimates were derived using validated thresholds from the Maslach Burnout Inventory (3rd ed.), offering a comparative context that supports the generalizability of our findings.\u003c/p\u003e\u003cp\u003eThe notably high \u003cb\u003eemotional exhaustion\u003c/b\u003e (~\u0026thinsp;56%) and \u003cb\u003edepersonalization\u003c/b\u003e (~\u0026thinsp;45%) rates suggest that long hours, responsibility, and emotional toll are nearly universal features of surgical residency stressors. These results support that burnout remains a significant threat to the psychological well-being of residents across different healthcare systems and cultural contexts.\u003c/p\u003e\u003cp\u003eThe notably high emotional exhaustion scores across countries suggest that long hours, high responsibility, and emotional demands are nearly universal stressors in surgical training. This trend has been previously described as a hallmark of early residency burnout (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cb\u003eBurnout and Training Environment\u003c/b\u003e\u003c/p\u003e\u003cp\u003eCountry-specific differences in burnout scores (particularly in emotional exhaustion and depersonalization) may reflect variations in institutional support systems, resident workloads, and healthcare infrastructure. For example, in our study, residents in certain countries reported statistically higher emotional exhaustion levels than their counterparts, indicating systemic disparities in workload distribution or access to resources. These findings are consistent with other Middle Eastern studies, including a Palestinian survey that found financial stress and job dissatisfaction to be major burnout predictors (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eImpact of Years of Experience\u003c/b\u003e\u003c/p\u003e\u003cp\u003eWe observed significant associations between burnout scores and years of residency training. Emotional exhaustion and depersonalization were highest in mid-level residents (PGY-2 to PGY-3), a pattern also found in previous literature (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). This may be due to the transition from observer to independent operator, increased on-call burden, and growing expectations for clinical and academic performance without proportional support.\u003c/p\u003e\u003cp\u003e\u003cb\u003eWorkload and Support Correlations\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAccording to our research, correlation analysis revealed that workload was perceived as a significant contributor to burnout severity. Residents who reported higher work demands, including longer working hours and frequent on-calls, were more likely to experience emotional exhaustion. These findings are similar to those of a meta-analysis, which showed that long duty hours were a strong predictor of burnout in surgical fields ( 9).\u003c/p\u003e\u003cp\u003eAlthough not statistically significant, a weak inverse correlation was observed between burnout and perceived institutional support. This suggests that residency programs with structured mentorship, mental health access, and workload moderation may help mitigate the effects of stress, a recommendation consistent with recent interventions in UK and Canadian programs (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cb\u003eStrengths and Limitations\u003c/b\u003e\u003c/p\u003e\u003cp\u003eA major strength of this study is its multicenter, international design, capturing a diverse range of surgical training environments in the Middle East. It also adds to the limited literature using regionally contextualized burnout metrics rather than Western-validated tools alone.\u003c/p\u003e\u003cp\u003eHowever, several limitations must be acknowledged. First, the use of a custom questionnaire, though tailored to the study context, limits comparability with other research using standardized tools like the MBI or CBI. Second, self-reporting introduces the potential for social desirability and recall bias. Lastly, the cross-sectional design precludes causal inference; longitudinal studies are needed to assess burnout progression and response to interventions.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis cross-sectional study highlights the substantial burden of burnout among surgical residents in Egypt, Jordan, and Palestine. Emotional exhaustion and depersonalization were prevalent and significantly associated with perceived workload, years of training, and country-specific factors. These findings emphasize the urgent need for surgical training programs in the region to implement structured support systems, regulate workload demands, and foster environments that prioritize resident well-being.\u003c/p\u003e\u003cp\u003eAddressing burnout is not only essential for preserving the mental health of future surgeons but also for ensuring patient safety and the sustainability of healthcare systems. Further longitudinal and interventional research is recommended to guide targeted reforms in residency curricula and workplace policies.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Institutional Review Board (IRB) at Palestine Polytechnic University. Participation was voluntary, anonymous, and all respondents provided informed consent by completing the online questionnaire. This research was conducted in accordance with the principles outlined in the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors received no funding for this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003col start=\"1\" type=\"1\"\u003e\n \u003cli\u003eMohammed Ehmidat: Study concept and design, project leadership, coordination, and manuscript drafting.\u003c/li\u003e\n \u003cli\u003eKhaled Dawabsha: Study design assistance, data acquisition, data collection, and manuscript revision.\u003c/li\u003e\n \u003cli\u003eAhmad Manasrah: Data analysis, data interpretation, and critical manuscript revision.\u003c/li\u003e\n \u003cli\u003eHossam Salameh, Hasan Khalili, Salem Waleed, Shahd Shanann, Sujood Abudaia, Mohanad Jaber, Husein Sarahneh: Data collection, literature review, table/figure formatting, field coordination, and manuscript preparation.\u003c/li\u003e\n \u003cli\u003eSulaiman Naji Fakhouri: Surgical expertise, methodology supervision, and critical content review.\u003c/li\u003e\n \u003cli\u003eMohamed M. Soffar: Senior mentorship, data analysis review, and manuscript intellectual revision.\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eAll authors reviewed and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe thank all surgical residents who took the time to complete our survey. We are also grateful to faculty members in the participating institutions who helped facilitate data collection and IRB approval.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Trial Number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eMaslach C, Jackson SE, Leiter MP. Maslach Burnout Inventory Manual [Internet]. Consulting Psychologists Press; 1996. Available from: https://books.google.ps/books?id=hhgvNQAACAAJ\u003c/li\u003e\n\u003cli\u003eElmore LC, Jeffe DB, Jin L, Awad MM, Turnbull IR. National Survey of Burnout among US General Surgery Residents. J Am Coll Surg. 2016 Sep;223(3):440\u0026ndash;51.\u003c/li\u003e\n\u003cli\u003eDyrbye LN, Thomas MR, Shanafelt TD. Systematic Review of Depression, Anxiety, and Other Indicators of Psychological Distress Among U.S. and Canadian Medical Students: Acad Med. 2006 Apr;81(4):354\u0026ndash;73.\u003c/li\u003e\n\u003cli\u003eShanafelt TD, Balch CM, Bechamps G, Russell T, Dyrbye L, Satele D, et al. Burnout and Medical Errors Among American Surgeons. Ann Surg. 2010 Jun;251(6):995\u0026ndash;1000.\u003c/li\u003e\n\u003cli\u003eShawahna R, Maqboul I, Ahmad O, Al-Issawy A, Abed B. Prevalence of burnout syndrome among unmatched trainees and residents in surgical and nonsurgical specialties: a cross-sectional study from different training centers in Palestine. BMC Med Educ. 2022 Dec;22(1):322.\u003c/li\u003e\n\u003cli\u003eAl-Humadi S, Bronson B, Muhlrad S, Paulus M, Hong H, C\u0026aacute;ceda R. Depression, Suicidal Thoughts, and Burnout Among Physicians During the COVID-19 Pandemic: a Survey-Based Cross-Sectional Study. Acad Psychiatry. 2021 Oct;45(5):557\u0026ndash;65.\u003c/li\u003e\n\u003cli\u003eAshouri M, Mansourian B, Safari R, Mohammadzadeh N, Tadbir Vajargah K, Karimi A. Burnout in Surgical Residents of an Academic Hospital in Iran: A Cross‐Sectional Study. World J Surg. 2023 Jan;47(1):72\u0026ndash;7.\u003c/li\u003e\n\u003cli\u003eDyrbye LN, West CP, Satele D, Boone S, Tan L, Sloan J, et al. Burnout Among U.S. Medical Students, Residents, and Early Career Physicians Relative to the General U.S. Population: Acad Med. 2014 Mar;89(3):443\u0026ndash;51.\u003c/li\u003e\n\u003cli\u003eRodrigues H, Cobucci R, Oliveira A, Cabral JV, Medeiros L, Gurgel K, et al. Burnout syndrome among medical residents: A systematic review and meta-analysis. Junne FP, editor. PLOS ONE. 2018 Nov 12;13(11):e0206840.\u003c/li\u003e\n\u003cli\u003eWest CP, Dyrbye LN, Erwin PJ, Shanafelt TD. Interventions to prevent and reduce physician burnout: a systematic review and meta-analysis. The Lancet. 2016 Nov;388(10057):2272\u0026ndash;81.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Burnout, surgical residents, workload, cross-sectional study, Middle East, emotional exhaustion, depersonalization","lastPublishedDoi":"10.21203/rs.3.rs-7101378/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7101378/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eBurnout is a common issue among surgical residents, caused by excessive workload, emotional strain, and insufficient support systems. While global studies have addressed this challenge, still limited data exist from Middle Eastern residency programs.\u003c/p\u003e\u003ch2\u003eObjectives\u003c/h2\u003e\u003cp\u003eTo assess the prevalence and severity of burnout among surgical residents in Egypt, Jordan, and Palestine, and to examine its association with workload, experience level, and training environment.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eThis multicenter, cross-sectional study was conducted between May and July 2025 among surgical residents using a custom-designed burnout questionnaire. The survey assessed emotional exhaustion, depersonalization, and perceived workload. Data were analyzed using descriptive statistics, Chi-squared tests, Kruskal-Wallis tests, and Spearman correlations.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eA total of 102 residents responded. According to thresholds taken from the Maslach Burnout Inventory Manual (3rd ed.), an estimated \u003cb\u003e60% of respondents\u003c/b\u003e experienced moderate-to-severe burnout symptoms. Emotional exhaustion (~\u0026thinsp;56%) and depersonalization (~\u0026thinsp;45%) were the most affected domains. Significant associations were found between burnout scores and country of training (χ\u0026sup2; = 33.02, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), years of experience (χ\u0026sup2; = 9.71, p\u0026thinsp;=\u0026thinsp;0.045), and perceived workload (ρ\u0026thinsp;=\u0026thinsp;0.23, p\u0026thinsp;=\u0026thinsp;0.021). Institutional support showed a weak inverse correlation with burnout (ρ = \u0026minus;\u0026thinsp;0.18, p\u0026thinsp;=\u0026thinsp;0.063).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eBurnout is highly prevalent among surgical residents in the studied countries and is significantly influenced by workload and stage of training. Residency programs should adopt systemic interventions focused on workload regulation, psychological support, and institutional reform to reduce burnout and enhance surgical education outcomes.\u003c/p\u003e","manuscriptTitle":"Effect of Burnout Due to Heavy Workload on Surgical Residents: A Multi-National Cross-Sectional Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-23 02:28:59","doi":"10.21203/rs.3.rs-7101378/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"8a860bef-2a15-4648-aa50-0f7c9a5c1a82","owner":[],"postedDate":"July 23rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-02-02T04:25:15+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-23 02:28:59","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7101378","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7101378","identity":"rs-7101378","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}